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Daytime cardiac repolarization in patients with obstructive sleep apnea

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Abstract

Purpose

Obstructive sleep apnea (OSA) has been implicated in complications of cardiovascular disease, including arrhythmias and sudden cardiac death (SCD). Prolonged QT interval is associated with arrhythmias and SCD in patients with cardiovascular disease and apparently healthy humans. Apneic episodes during sleep in OSA patients are associated with QT prolongation due to increased vagal activity, but it is not understood whether chronic QT prolongation persists during normoxic daytime wakefulness.

Methods

To determine whether daytime QT intervals in OSA patients are prolonged compared to control subjects, we recruited 97 (76 male, 21 female) newly diagnosed patients with OSA [apnea-hypopnea index (AHI) ≥5 events/h] and 168 (100 male, 68 female) healthy volunteers (AHI <5 events/h) and measured daytime resting QT and RR intervals from the electrocardiograms to determine QT prolongation corrected for heart rate (QTc).

Results

All subjects with OSA were older and heavier, with increased heart rate, significantly increased AHI and arousal index, and reduced oxygen saturation (SpO2) during sleep, and spent less time in sleep with >90 % SpO2 compared to respective controls. QTc in patients with OSA (410 ± 3.3 for male and 433 ± 5.6 for female) was significantly increased compared to respective control groups (399 ± 2.9 for male and 417 ± 2.9 for female), after adjustment for age and body mass index.

Conclusions

Our data show that OSA in either men or women is associated with a significant increase in resting daytime QTc. The propensity for ventricular arrhythmias in patients with OSA may be a result of abnormalities in resting cardiac repolarization.

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Acknowledgments

The authors are grateful to J. Denise Wetzel, CCHMC Medical Writer, for critical review of the manuscript.

Funding

These studies were supported by a Perkins Memorial Award, an American Heart Association Scientist Development Grant (0730129N, AS) and AHA Fellowship Grant (09-20069G, FSK), and the National Institutes of Health (NIH) grants HL-70302, HL-65176, TW05463, TW05469, and 1 UL1 RR024150. This publication was made possible by CTSA Grant Number UL1 TR000135 from the National Center for Advancing Translational Sciences (NCATS), a component of the NIH. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NIH.

Conflict of interest

Dr. Somers has served as a consultant for Respicardia, NeuPro, and ResMed and is an investigator on studies funded with grants from the Philips Respironics Foundation. Dr. Pressman has received funding from the Philips Respironics Foundation. The other authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Cincinnati Children’s Hospital Medical Center, MLC 2021 3333 Burnet Ave, Cincinnati, OH, 45229, USA

    Abu Shamsuzzaman & Raouf S. Amin

  2. Mayo Clinic, Rochester, MN, USA

    Abu Shamsuzzaman, Christelle van der Walt, Diane E. Davison, Aynur Okcay & Virend K. Somers

  3. Albert Einstein Medical Center, Philadelphia, PA, USA

    Gregg S. Pressman

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  1. Abu Shamsuzzaman
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  2. Raouf S. Amin
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Correspondence to Abu Shamsuzzaman.

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Shamsuzzaman, A., Amin, R.S., van der Walt, C. et al. Daytime cardiac repolarization in patients with obstructive sleep apnea. Sleep Breath 19, 1135–1140 (2015). https://doi.org/10.1007/s11325-015-1119-9

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